- Assignment 5 3 Obtain Authorization For Physical Therapy From A Managed Care Plan Performance Objective Complete A Treat 1 (256.6 KiB) Viewed 15 times
- Assignment 5 3 Obtain Authorization For Physical Therapy From A Managed Care Plan Performance Objective Complete A Treat 2 (205.34 KiB) Viewed 15 times
ASSIGNMENT 5.3 OBTAIN AUTHORIZATION FOR PHYSICAL THERAPY FROM A MANAGED CARE PLAN Performance Objective Complete a treatment authorization form to obtain permission for physical therapy for a patient covered by a managed care plan. Use a treatment authorization form (Fig. 5.3), computer, and printer. Time: minutes Accuracy: (Note: The time element and accuracy criteria may be given by your instructor.) Directions: Complete the treatment authorization form for this patient (see Fig. 5.3), date it July 7 of the current year, and submit it to the managed care plan. Refer to Fig. 5.2 in the Textbook for visual guidance. Task: Conditions: Standards: Scenario: Mrs. Rosario Jimenez comes into Dr. Gerald Practon's office complaining of neck pain. Mrs. Jimenez is a member of the managed care program HealthNet, and Dr. Practon is her primary care physician. Mrs. Jimenez lives at 350 South Carib Street, Woodland Hills, XY 12345-0003. Her telephone number is 555-450-9987, and she was born April 6, 1960. Her plan identification number is JIM40896, and the effective date is January 1, 20xx. After taking a history, completing a physical examination, and taking and reviewing radiographs, Dr. Practon makes a diagnosis of cervical radiculitis. He gives Mrs. Jimenez a prescription for some medication and says it is necessary to order outpatient physical therapy (one area, for 15 minutes; therapeutic exercises to develop strength, motion, and flexibility) twice a week for 6 weeks at College Hospital. Authorization must be obtained for this treatment. Dr. Practon's HealthNet provider number is HN C01402X. After the instructor has returned your work to you, either make the necessary corrections and place your work in a three-ring notebook for future reference or, if you receive a high score, place it in your portfolio for reference when applying for a job.
College Clinic 4567 Broad Avenue Woodland Hills, XY 12345-0001 Telephone No. (555) 487-8976 Fax No. (555) 487-8976 MANAGED CARE PLAN AUTHORIZATION REQUEST TO BE COMPLETED BY PRIMARY CARE PHYSICIAN OR OUTSIDE PROVIDER Patient Name Male Address Primary Care Physician R Practon, MD Referring Physician. DR Practin, MD College Hospital' Referred to Jimenez 07/07/2022 Rosario Female Birthdate Fando Bisouth Caribst, Woodland Hills XY 12345 HN CO1402X HN CO 1402 Address Diagnosis Code. Diagnosis Code. Treatment Plan Authorization Requested for: Consult Only Procedure Code: Procedure Code: Place of Service Office Facility: Physician's Signature: Consult/Procedure/Surgery Description:. Description: College Hospital OF Treatment Only Outpatient Inpatient Other Diagnosis. Diagnosis. Copyright © 2020 Elsevier, Inc. All Rights Reserved. TO BE COMPLETED BY PRIMARY CARE PHYSICIAN PCP Recommendations: Date Eligibility Checked: TO BE COMPLETED BY UTILIZATION MANAGEMENT Authorized: Deferred: Effective Date: Auth. No:. Modified: Expiration Date: XHealth Net Pacificare Secure Horizons Other Member/Group No. Fig. 5.3 Date _NPI NPI NPI. Initials: physical therapy 2x a week for & week July 1071 2022 Telephone No. Cervical Radiculitis Consult/Treatment Diagnostic Tests Number of Visits: Length of Stay:. Not Authorized Met Life Travelers Pru Care No. of Visits: 12 6 weeks SOR 5 Chapter 5 The Blue Plans, Private Insurance, and Managed Care Plan